Provider First Line Business Practice Location Address:
341 STAR RT 104 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13126-2911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-342-2212
Provider Business Practice Location Address Fax Number:
315-342-2225
Provider Enumeration Date:
02/23/2010